In response to
heightened awareness of Medicaid fraud and abuse and in response
to a Statewide Grand Jury report released in December, 2003, the
Legislature passed SB 1064, a bill that addressed many aspects
of fraud and abuse in the Medicaid program. FCEP worked to
educate policymakers on the unique nature of emergency medical
care. Legislators granted exceptions to emergency care in
several areas in the final legislation:
1) A section of the bill initially would have allowed AHCA to
obtain a second opinion of a correct diagnosis and to
retroactively deny payment for Medicaid services already
provided to patients. The bill was modified to make the “second
opinion” applicable only to approval of future services under
the Medicaid program, and to specifically exclude emergency care
from the “second opinion” provision.
2) A section of the earlier drafts provided for certain
penalties or non-payment of providers in circumstances where
prescriptions for medications, medical supplies or medical
services were provided upon the prescription of a physician who
is not enrolled as a Medicaid provider. This would have
detrimentally affected the provision of emergency services to
patients presenting to hospital emergency departments.
Legislators agreed that, relative to this provision, care
provided to patients in a hospital emergency department setting
should not be subject to such penalty.
3) The legislation enabled AHCA to mandate a recipient’s
participation in a provider “lock-in” program, thereby limiting
the receipt of goods and services to a single specified
provider. This “lock-in” provision was modified to clarify that
the limitation would not be applicable to emergency services
provided to a recipient in a hospital emergency department.
In addition to these emergency medicine specific issues that
were the focus of FCEP, the FMA worked diligently to address
other issues affecting the due process rights of physicians in
general and issues felt to have a negative impact on patients.
